Magnitude of Medicine Wastage and Perceived Contributing Factors Among Public Health Facilities in Dire Dawa City Administration, Eastern Ethiopia in COVID-19 Pandemic in Ethiopia

Magnitude of Medicine Wastage and Perceived Contributing Factors Among Public Health Facilities in Dire Dawa City Administration, Eastern Ethiopia in COVID-19 Pandemic in Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Magnitude of Medicine Wastage and Perceived Contributing Factors Among Public Health Facilities in Dire Dawa City Administration, Eastern Ethiopia in COVID-19 Pandemic in Ethiopia Abera Bedasa, Neil Abdurashid, Kiber Argaw This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1842136/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background World Health Organization refers medication waste as expired, unused, spilled, and contaminated pharmaceutical items, medications, vaccines, and sera. Budget constraints in financing the health care system together with huge amount of wastage and disposal costs of unused medications at LMIC create a serious risk to the economy, health care system and environment. Thus, the aim of this study was to assess the rate of medication waste and to identify contributing factors in public health facilities in Dire-Dawa city. Methods An institution-based cross-sectional study was used with a qualitative study design from May 10 to June 10, 2021 at 2 public hospitals and 14 health centers. Self-administered questionnaires and data abstraction formats were used to obtain the quantitative data. In-depth interviews were used to obtain qualitative data. Excel sheets and SPSS version 20 were used to analyze quantitative data, and thematic analysis was used to analyze qualitative data. Results 3.07% of medicines were wasted between 2010 and 2012 EFY, in Dire-Dawa public health facilities that worth 4,048,594.0 ETB. The most wasted class of medication was anti-infectives, accounting for 2,360,330 ETB (58.3%), while tablets 2,615,391. ETB (64.6%). Medical waste has been linked to several issues, including pushing nearly expired medications to healthcare institutions, lack of clinician involvement in medication selection and quantification, rapid changes in treatment regimens, and the existence of overstocked medication shelves. Conclusion The average rate of medication waste was higher than the allowed level of 2%. The only medications that should be accepted by medical facilities are those that can be used before they expire. All prescribers should receive lists of the drugs that are readily available from the pharmacy department, and clinicians should be involved in the quantification and drug selection processes to increase the effectiveness of the use of medications. Medicine wastage contributing factors Figures Figure 1 Figure 2 Background International agreements and national governments around the world all recognize the right to health as a fundamental human right. Medication has long been a necessity in healthcare programs, and it has significantly improved population health over time ( 1 ).The World Health Organization defines pharmaceutical or medication waste as products that are no longer in use, have been spilled, or are contaminated. This includes drugs, vaccines, and sera ( 2 ). The volume of pharmaceutical waste has increased as a result of an increase in patients and prescriptions, increased usage, and overproduction of pharmaceuticals ( 3 ). When medication is available and properly administered, it plays a critical role in the provision of healthcare and has been shown to increase patient attendance and client satisfaction ( 11 ). Pharmaceuticals that are out-of-date or past their expiration date endanger both the environment and the healthcare system ( 4 ). Due to the healthcare system's financial limitations, as well as the enormous amounts of medication that are wasted and the associated disposal costs in low- and middle-income countries, both the healthcare system and the overall economy will be seriously threatened ( 5 ). As worrying as the disposal of expired medications are the financial losses imposed on national healthcare systems and on particular patients. Pharmaceutical waste also poses a significant risk to the environment and has negative impact on public health if improperly disposed of. In areas where unused medications were disposed of, numerous types of bacteria resistant to antibiotics were discovered ( 6 ). It has been shown that antibiotics that accumulate in aquatic environments worsen antibiotic resistance and affect the pathogenicity of microorganisms ( 17 ). Additionally, the amount of necessary medications that patients have access to and the level of care they receive are both decreased as a result of prescription waste, putting human life in danger ( 10 ). The degradation of medicines can be brought on by unsanitary storage conditions, such as placing medicines directly on the floor, not organizing the stock in a systematic way, having dust and pests, not providing adequate protection from direct sunlight, and not having temperature control charts or facilities to monitor room temperature. Additionally, inadequate inventory control, which is blamed for the loss of 4 to 9 percent of pharmaceuticals in overall supply systems, is cited as a contributing factor ( 7 , 8 ). More than half of all medicines are inappropriately prescribed, dispensed or sold. Such techniques are thought to be more common in healthcare settings in underdeveloped countries, where there are still weak routine monitoring procedures for medication use ( 14 ). According to Variant Market Research, an Indian data mining and information analysis company, the global over-the-counter drug (OTC) market is expected to grow from USD 125 billion in 2016 to USD 273 billion by 2024. Only a small portion of this is currently being used, and the majority will eventually be wasted or expire, generating a sizable amount of pharmaceutical waste ( 12 ).The annual costs associated with unused prescription medications are estimated by the National Health Service of the United Kingdom (UK) to be £300 million ( 13 ). Despite a significant sum of money spent on drug procurement, one-third of the world's population lacks access to medicines, which rises to one-half in Asia and Africa. This explanation is that due to a poor medicine management system, up to 70% of resources have been wasted.( 15 ). A Tanzanian study found that up to 51.1% of the total amount of prescribed medications were wasted ( 16 ). Drug waste in low-income countries is a result of inadequate supply chain management systems. In addition to patient-related considerations, this includes tactics that might lead to medication over- or under-stocking as well as the selection and quantification of medications without the use of reliable data or supporting evidence. (Patient death, switching medications, discontinuing therapy, side effects, and low patient compliance) ( 18 ). One of the difficulties in managing Ethiopia's medical supply chain is drug waste ( 21 ).The Health Sector Development Program (HSTP II) has as its national objective to reduce the wastage rate of medicines to below 2%, but the reality is very different ( 9 , 19 ). Ethiopia, like other developing countries, must pay close attention to a problem with the health supply chain caused by drug waste. The three-year (2012, 2013, and 2014) average medicine wastage rate in 8 hospitals was 4.8 percent, amounting to 11,078,910.52 ETB, according to an evaluation carried out in 2013/2014 during the collection of Auditable Pharmaceutical Transaction and Services (APTS) baseline data in Federal and Addis Abeba city government hospitals ( 10 ). The primary causes of medical waste in Ethiopia are poor governance, a lack of auditing procedures, transparency, and accountability in the pharmaceutical system, which increase healthcare costs and deplete the nation's meager health system resources ( 19 ). Additionally, there aren't enough regulations requiring medical facilities to monitor and report drug waste across the country or tools to automatically collect waste. Due to all of these factors, Ethiopia wastes a significant amount of medicine, necessitating immediate attention and action ( 10 ). Poor documentation, a lack of accountability, a lack of tools or software that automatically collect data, and a lack of a system requiring health facilities to record and report wastage to the body in the supply chain that is directly affected are all causes of medicine waste in Ethiopia ( 9 , 10 ). According to a study conducted in the Awi zone, the Pharmaceuticals Fund and Supply Agency (PFSA) frequently pushed program products and occasionally Revolving Drug Fund items at the medical facilities that were unnecessary and occasionally on the verge of expiration. A lack of data during service expansion, problems with reporting consumption data from wards, failure to take quantity into account when ordering, a store employee's lack of inventory management skills, the ineffectiveness of medications or lack of response and the ensuing change are additional factors. They include different prescription practices used by prescribers, quantification issues (particularly with seasonal products), poor data quality, and an ineffective Drug and Therapeutics Committee (DTC). The main factors behind the ward's insufficient use of medications were health professionals' knowledge gaps ( 20 ). In Dire-Dawa city administration, medications are regularly discarded by the Dire-Dawa regional health bureau from public health facilities; however, the type and extent of medicine waste as well as its contributing factors were not investigated. Therefore, this study provides information about the extent, identifies the types of wasted medicines and their underlying causes and fills the gaps in how to properly utilize medicines and minimize the wasted cost of money by developing different strategies in the public health facilities of Dire-Dawa city administration. Methods And Materials Study area and period The study was conducted in the Dire Dawa Administrative city, which is located 515 km away from Addis Ababa. The current projected the Metro area of Dire Dawa in 2020 was 408,000 a 4.35% increase from 2019. According to the report by the Dire-Dawa health bureau, during the surveying time the city administration had 2 public hospitals (Dill Chora Hospital and Sabian Hospital), 15 health centers and 35 health posts. Apart from these, there were 1 Hospital, 3 primary Hospital, 32 medium clinics, 7 primary clinics, 17 pharmacy, 53 drug stores, 3 diagnostic laboratories possessed by private owners. A facility-based cross-sectional study was conducted by supplemented qualitative study design that was employed from May 10 to June 19, 2021. Sampling size determination and sampling technique All health facilities that fulfilled the inclusion criteria were included in the study. All public health facilities which had more than 3 years in operation and health professionals involved in pharmaceutical management in Dire-Dawa city administration were included in the study. No sampling method was used because all 17 health facilities (2 Hospitals and 15 health centers) were included in the study. Out of these one health center was selected for pretest which was excluded from study during data collection, finally a total of 16 health facilities were included in the study. For quantitative study the number of study population ( all health professional engaging in Drug and therapeutic committee (DTC) and all pharmacy professionals working in 16 public health facilities of Dire-Dawa city administration were 163 and for qualitative study the number of study population, (the chief executive officers (CEOs)/Health center head, pharmacy store manager and pharmacy departments head working in 16 public health facilities of Dire-Dawa city administration) was 48.They were purposively selected as a key informant because they were supposed to be information rich than other health professionals. Data Quality control The study questionnaire was developed after reviewing different literature and made available in English to be read and a pretest study was performed in one of public health facilities. Two pharmacists for data collectors were involved by using data abstraction formats and self-administered questionnaires and principal investigator through in-depth interview with the CEOs/health facility head, pharmacy store manager and pharmacy department head. Data collectors received training for one day. To collect the qualitative data, the principal investigator conducted in-depth interviews using the IDI guide to understand the perceptions of participants about the medication wastage. The principal investigator used a tape recorder to record the interview and filed notes on important points. Appropriate personal protective equipment (PPE), such as sanitizer and a facemask, was used by the data collectors and the study participants before undergoing data collection. Data instrument and Processing The quantitative data was collected through record review by recording each pharmaceutical on the data abstraction form. Records that were reviewed include: physical inventory report, records of medicines wastage, disposal reports, model 19 and HCMIS (DAgu2). Medicines wastage recording format and wasted value recording format were prepared based on pharmaceutical monitoring and evaluation framework (42) and EFMHACA medicines waste management and disposal directive(43). Self-administered questionnaire which has perceived contributing factors of medicines wastage was amended from literature. Every point is score on a 5 point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) (36) . A semi-structured interviewer-administered questionnaire about condition of medicines wastage, contributing factors, concerns and efforts in preventing or minimizing the problem for store personnel, pharmacy heads, and medical directors were developed after literature search (16,44). Data entry analysis For quantitative study Self-administered questionnaires were entered in to Epi Data version 3.1 then exported to SPSS version 20 for analysis Descriptive statistics (Frequency, Mean, Standard Deviation (SD), percentage and graph) were used to summarize the results. Self-administer questionnaire with a 5- point likert scale ranging from 1(strong disagree) to 5 (strong agree) was used to identify perceived contributing factors for medicine wastage. The perceived factors which had highest mean score (mean± SD)>=4 were the most commonly perceived factors contributing to medicine wastage. Excel sheet was used for calculating medicine wastage for each public health facilities through dividing total cost of medicines wasted from medicines wastage registration and disposed medicines lists by total cost of medicine available for sale during review period. The value of wasted medicine was grouped by dosage form and pharmaco-therapeutic classes. For the qualitative study The principal investigator had had undergone in-depth interview to understand the perceptions of participants about the medication wastage. The investigator transcribed the audio recorded in-depth interviews and discussions verbatim. Audio-recordings and notes were translated into English. Then codes were given and issues were discussed and themes were developed. Later, the text relating to each code/theme was discussed and summarized in sub themes and presented the findings using quotes. The codes were developed from the texts and it was categorized as the following terms: current situation of medicines wastage, medicine wastage and its contributing factors. The themes that developed from the codes would be supplemental for reasons for medicine wastage and factors leading to medication wastage. Each transcript was carefully screened and triangulated with the quantitative result. Ethical consideration Ethical clearance was obtained from the Ethics Review Committee of Dire Dawa University, and a formal letter of cooperation was written to the Dire-Dawa city administration health bureau and to each respective public health facilities. Data collectors were trained how to handle sensitive issues and on the importance of keeping confidentiality. Informed voluntary written and signed consent was obtained from all study participants prior to undertaking interview. During the consent process, the respondents were informed about the purpose, procedures, potential risk and benefit of the study and what was expected from them, their rights to participate or not in the study. Information provided by respondents was not transferred to a third party or was used for any other purpose other than academic. Thus, they were assured of utmost confidentiality and anonymity of their responses. In this regard, the names of the respondents were not disclosed. The room and the environment were made conducive to maintain their privacy and to prevent COVID-19 transmission. Result The data were gathered from primary sources using data abstraction formats, self-administered questionnaires and semi structured interview questionnaires. A total of 16 public health facilities (14 health centers and 2 general hospitals) were included in the studies. Of these facilities, 13 (2 general hospitals and 11 health centers) executed HCMIS initiatives, while APTS initiatives were implemented only in town health facilities. The results presented include the magnitude of the medicine wastage rate in each public health facility and Dire-Dawa city administration, therapeutic class of wasted medicine, dosage form of wasted medicines, reason for medicine wastage, perceived factors contributing to medicine wastage and the qualitative data presented thematically by narration. Quantitative findings Magnitude of medicine wastage The average wastage rate of medicines from the budget and program between 2010EFY and 2012EFY in two public hospitals and fourteen health centers in Dire-Dawa were found to be within a range of 0.36% to 5.8%. The highest average wastage rate was identified in Sabian General Hospital, which was 5.8%. Within the above specified time, the overall city administration wastage was 4048594.00ETB, accounting for an average wastage rate of 3.07% of the total value of medicines available for sale at sixteen public health facilities. Similarly, the medical supply and laboratory reagent amount to 275335.00 ETB and 559618.80ETB, respectively, were wasted. In EFY 2010, there was an overall wastage of 1404987.7 ETB, accounting for an average of 3.3% of the total value of medicines available for sale by sixteen health facilities. In 2011 EFY, the value of wastage was estimated to be 1204188.00 ETB, indicating an annual wastage rate of 2.7% for sixteen of the study health facilities, while in 2012EFY, there was an overall wastage of 1439418.284 ETB, in which the annual wastage rate was estimated to be 3.2%. (Table-1) Table 1. The value of medicines (available for sale and wasted) and estimation of total medicine wastage rate in the facilities (EFY2010-2012), Dire-Dawa city administration, Ethiopia, June 2021 (n=16) Health facility code 2010EFY 2011EFY 2012EFY medicine available for sale in birr wasted in birr Wastage rate (%) medicine available for sale in Birr wasted in Birr Wastage rate (%) medicine available for sale in Birr wasted in Birr Wastage rate (%) AKHC 2192082 46925 2.1 2481882 80517 3.2 2831765 60601 2.1 BAHC 1008172 28764 2.9 885406 35595 4.0 1080267 8346 0.8 DaHC 1586114 33819 2.1 1391152 28198 2.0 1850782 33070 1.8 DCRH 16140258 811056 5.0 23599043 604186 2.6 19011787 627389 3.3 DDHC 2064095 20684 1.0 2250357 37088 1.6 2297609 75897 3.3 GaKHC 1885183 37017 1.9 1574517 38284 2.4 3421475 104116 3.0 GGHC 1627348 12568 0.8 1614622 36656 2.3 2068214 21309 1.0 GHC 1551755 95800 6.2 1640247 74720 4.6 2846653 84684 2.9 LHHC 3043648. 77682 2.6 3905557 23152 0.6 4403320 207345 4.7 SGH 7732853 166545 2.1 2183006 172878 7.9 1843078 138484 7.5 WHC 707911 1946 0.3 794384 2807 0.4 917392 3792 0.4 JHC 448464 19059 4.3 407946 17902 4.4 539817 14573 2.6 KHC 584476 18047 3.0 672366 15431 2.3 601123 22992 3.8 MKHC 477920 16503 3.5 351217 14696 4.2 356437 11992 3.4 LOHC 722379 3916 0.6 497691 4980 1.0 647632 6058.8 0.9 JBHC 410900 14649 3.6 420630 17098 4.0 551500 18763 3.4 wastage rate 42183564 1404987 3.3 44670031 1204188 2.7 45257064 1439418 3.2 Types of wasted medicines Classes of wasted medicines A total of 237 types of medications were wasted at the 2 hospitals and 14 health centers in the period of EFY 2010-2012. Anti-infective medications were found to be the most wasted medications at 2360330.33ETB (58.3%), followed by endocrine medications at 647775.05ETB (16%) and gastrointestinal medications at 368422.06 ETB (9.10%). (Table 2). Table 2. Estimated value of wastage of medicines by classes in the study facilities (EFY2010-2012), Dire-Dawa city administration, June 2021 class of medicines value of wasted medicines Cost(Birr) % Ant-infective 2360330.33 58.3 Medicine used in endocrine disorder and contraceptives 647775.05 16 Gastrointestinal medicine 368422.06 9.1 Cardiovascular medicines 214575.48 5.3 Central nervous system medicines 149798.98 3.7 Vitamin and minerals 117409.23 2.9 Analgesics/antipyretics 85020.48 2.1 Medicine for corrective water electrolyte and acid -base disturbance 52631.72 1.3 Antihistamine and ant allergic 35627.63 0.88 Respiratory medicines 17004.1 0.42 Total 4048594 100 Medicine wastage by dosage form Wasted medicine was categorized into different dosage forms. Out of the wasted medicines, oral medicines were the most wasted in terms of the monitory value 3348187.278 (82.7%), followed by parenteral 495952.7709 (12.25%) and Trans dermal 126720.9937 (3.13%). (Table 3) Table 3. Estimated values of wastage of medicines by dosage forms in the study facilities (EFY2010-2012), Dire-Dawa city administration, Ethiopia, June 2021. Type of dosage form Value in ETB % Tablet 2615391.755 64.6 Capsule 518220.0382 12.8 Injection 461539.7215 11.4 Suspension 125506.4155 3.1 Cream 100000.273 2.47 Syrup 89069.06907 2.2 Suppository 64777.50478 1.6 Solution 34413.04941 0.85 Ointment 24696.4237 0.61 Drop 12550.64155 0.31 Jell 2024.297024 0.05 Aerosols 404.8594049 0.01 Total 4048594.049 100 Reasons for medication wastage Reasons for medicine wastage were assessed during the study period. Expiration of medicine was found to be the major reason for medicine wastage, accounting for 3951427.791 ETB (97.6%) of the total value of medicine wasted, followed by damage 97166.25717ETB (2.4%). None of the health facilities under study recorded theft pilferage and Obsolete as the reason for medicine wastage. (Figure 2) Medicine wastage perceived contributing factors Demographic Characteristics of Respondents The questionnaires were distributed to 163 health professionals, for a response rate of 161 (98.77%). The study included 92 (57.1%) males. The majority of the respondents 102 (63%) were between 31 to 40 years old. Regarding educational status, 42 (26.1%) were diploma pharmacy graduates, and 41 (25.5%) were pharmacists. The majority of respondents (104, 64%) had 5-10 years of work experience. (Table 4 ) Table 4. Demographic features of self-administered questionnaire respondents in public health facilities, Dire-Dawa, June 2021 (n=161) Demography Characteristics Frequency n =161 Percent (%) Gender Male 92 57.1 female 69 42.9 Age 20-30 59 37 30-40 102 63 Profession Pharmacist 41 25.5 Diploma pharmacy 42 26.1 BSC nurse 28 17.4 General practitioner 7 4.3 Diploma nurse 12 7.5 BSC laboratory 9 5.6 Health officer 11 6.8 Other 11 6.8 Work experience 10 years 6 4 Perceived contributing factors to medicine wastage The study revealed that the major medicine wastage contributing factors were near expiration medicines being delivered to health facilities, no participation of clinicians in medicine selection and quantification, abrupt change treatment practices resulting in medicine wastage, the presence of overstocked medicines due to improper forecasting and lack of accountability for stock out and wastage medicine. (Table 5 ) Table 5. The perceived factors contributing to medicine wastage by health professionals in public health facilities of Dire-Dawa administration, Ethiopia, June 2021 (n=161). Contributing Factors Response Mean Standard deviation Strongly Disagree (1) Disagree (2) Neutral(3) Agree(4) Strongly agree(5) Total Near expiry medicines are being delivered to health facilities 0 0 4 42 115 161 4.7 0.51 No participatory of clinicians in medicine selection and quantification 5 6 12 68 70 161 4.19 0.95 Abrupt change treatment practices results medicines wastage 5 10 17 53 76 161 4.15 1.0 presence of over stocked medicines due to improper forecasting ofneed in the facility 17 21 15 69 39 161 3.57 1.27 lack of accountability for stock out and wastage medicine in the facility 21 20 27 43 50 161 3.50 1.38 Absence of functional DTC in the health facility 25 58 59 13 6 161 2.48 0.97 poor stock management like using neither FIFO nor FEFO in stock management 37 56 40 16 12 161 2.44 1.16 No accurate data available in health facility to facilitate quantification 36 59 54 5 7 161 2.3 0.99 lack of knowledge and skill of pharmacy professionals in medicine supply management 46 49 52 5 9 161 2.27 1.0 Medicine purchased without procurement plan 36 69 49 3 4 161 2.19 0.89 Selection of medicines are not based on medicine lists of facility 41 62 50 5 3 161 2.17 0.91 weak or no mechanism for medicine wastage monitoring and evaluation 40 68 47 2 4 161 2.14 0.9 Lack of system to move nearly expired medicines facility to facility 49 66 35 3 8 161 2.10 1.0 Lack of electronic stock management tools that automatically capture 44 75 33 6 3 161 2.06 0.89 Medicines are store on the floor not arranged systematical on shelf 42 85 28 1 5 161 2.02 0.86 Medicines that need cold temperature are not stored in a functionalrefrigerator in the health facility 51 68 32 8 2 161 2.02 0.91 Shortage of pharmacy human resources in the facility 56 68 30 3 4 161 1.95 0.9 Qualitative findings The key informants (KIs) were interviewed to find information about the current situation of medicine wastage in their facilities, factors that contribute to medicine wastage, the effect of medicine wastage on service provision and ideas for improving medicine wastage. They included drug store personnel, pharmacy heads, and health facility Socio-demographic characteristics of key informants Forty-eight health professionals working in sixteen public health facilities participated in this study as key informant interviewees. Of these, forty-eight (67%) were males. The mean age of the respondents was 30.7 years (SD= ±3.94), ranging from 26 to 42 years. In terms of profession, nineteen (39.9%) respondents were pharmacy technicians, thirteen (27%) were pharmacists, and nine (18.7%) were BSC nurses. The work experiences of the respondents ranged from 3 to 15 (6.8±3.25) years. (Table 6 ) Table 6. Demographic features of key informants in public health facilities, Dire-Dawa, 2021 (n=48). Socio-demographic profile Number Percentage Sex Male 32 67 Female 16 33 Age 20-30 years 28 58 31-40 years 18 38 >40 years 2 4 Profession Pharmacist 13 27 Pharmacy technician 19 40 BSC nurse 9 19 MSC nurse 2 4 MSC health officer 2 4 Health officer 2 4 General practitioner 1 2 Working experience in years 10 years 7 15 The situation of medicine wastage in public health facilities With regard to wastage, most of the key informants stressed that it was a major problem in their health facilities due to acceptance of donation of near-to-expiration medicines and overestimation of medicine during disease outbreaks. Some informants felt that medicine wastage was decreasing from time to time due to proper utilization of the FEFO system. Age range 35 to 40 year male pharmacy head mentioned the following: “Medicine wastage in our health facility is recently increasing due to donors pushing near expiry and excess products during the occurrence of different disease outbreaks in the region. For example, chikungunia, AWD and COVID-19, which are the main causes of the expiry of products, also push too many products, which results in an overstock of items. However, budget product wastage significantly decreases from time to time as a result of good forecasting practice. ” Conversely, some respondents believe that their health facilities medicine wastage is decreasing mainly due to a strong inventor control system. A 41-year-old female hospital CEO explained that: “Our health facility medicine wastage is on decreasing as a result of strong medicine data recording by using both computerized and manual recording system which enhanced accessibility of information to pharmaceutical managers and administrative that helped us in taking appropriate action before it get wasted. “ Perceived factors contributing to medicine wastage KIs were asked about the causes of the medicine wastage, and most of the respondents reported that no participation of clinicians in medicine selection and quantification, push near to expiry product from EPSA for program medicines, abrupt change treatment practices, presence of overstocked medicines due to improper forecasting during disease outbreak, lack of accountability for stock-outs and wastage of medicines in the facility were the main causes of the medicine wastage. Female store manager at her late 20s said that: “I think the main reason for medicine wastage in our health facility is the nonparticipation of prescribers in medicine selection during procurement. Sometimes clinicians prefer to prescribe certain medicines; hence, the other will expire due to a lack of consensus between the pharmacy department and prescribers. The other reason is pushing program products that are near-expiry and sometimes unnecessary at the health facilities; thus, it will expire before it is consumed.” Another key informant, a male health center director between the ages of 35 and 40, said: The main reason for medicine wastage is a sudden change in treatment practice. In our health facility program medicine, ART and TB medicine were especially wasted due to frequent changes in the treatment protocol. Another reason is pharmacy department is not accessed the lists of available medicine for prescribers as a result medicines are expired due to lack information.” Some key informants mentioned that forecasting error during disease outbreak, Excess procurement of medicine due to fear of shortage medicine from market, poor DTC functionality, slow move medicine (psychotropic medicines, expensive drugs and medicine with potential ADR), Prescribers dependent medicine order, Prescribers not adhere to STG, lack of accountability for wasted medicines and shortage of reagent were responsible for medicines wastage. A 33-year-old male pharmacy head mentioned: Some reagent dependent products were frequently wasted when their reagents were not available. added that other main cause of medicine wastage was oversupply medicine by donor and regional health bureau during episode chikungunia virus, AWD and covid-19 outbreak.” The consequence of medicine wastage on health facilities service delivery Key informants were asked for their view on the effect of medicine wastage on their service. The key informants disclosed that decreasing internal revenue and disposal costs, occupying space that could be used for usable medicines, environmental pollution and reducing client satisfaction were the main consequences mentioned by key informants. Another male health center head in his early 40s said that: “Health care need is increasing from time to time; however, annual medicine budget is constant or not significantly increases as result patients cannot get all medicine they need due to shortage of budget so this will be worsened when scarce resource is wasted. In addition, wasted medicine is occupies storage space that can be used for usable medicine.” Ideas for improving medicine wastage The respondents were asked to offer ideas on how to minimize medicine wastages in public health facilities. Participating clinicians in medicine selection and quantification, conducting regular discussion on medicine supply management with EPSA, using medicine transfer guidelines effectively, improving communication between prescribers and pharmacy departments, training for DTC and pharmacy professionals on medicine supply chain management were among the suggestions made to improve medicine wastage. Discussion The study mainly focused on assessing the medicine wastage rate, the class of medicines commonly wasted and its contributing factors in public health facilities in Dire-Dawa, Ethiopia. In this study, the average medicine wastage rate was found to be 3.07%, which is lower than the study done in southwest Shoa, zone (7.5%)(32)and Federal and Addis Ababa city government hospitals during the collection of the Auditable Pharmaceutical Transaction and Service (APTS) baseline data (4.8%) (12). This could be due to the implementation of different stock management initiatives, such as the integrated pharmaceutical logistic system (IPLS), auditable pharmaceutical transaction system (APTS), medicine transfer guideline, and electronic stock management tool. However, higher than the national target in the health Sector Transformation Program (HSTP, II) for medicines, the wastage rate is below 2% (9, 19). This might be due to receiving bulk and near expiration program medicines that will expire before being consumed by clients. The current study indicated a class of commonly wasted medicine. Anti-infective medications were found to be the most wasted medicines (58.3%), followed by medicines used in the endocrine system (16%) and gastrointestinal system (9.1%). Similar findings were reported by a study conducted at a tertiary hospital in Dar Es Salaam, Tanzania, in which anti-infective medicine wastage was 18.9%, cardiovascular medicine was 8.9%, and the other category was 23.7% of the total medicines dispensed (16). Another study conducted in Egypt, Cairo, also found that antibiotics were the most wasted medications (20.15%), followed by gastrointestinal system drugs (16.27) and cardiovascular system drugs (10.72%)(31). In addition, other studies conducted in Ethiopia also revealed that anti-infective medicines were the most wasted medicine. A study conducted in southwestern Shoa reported zone anti-infective (39.1%), followed by medicine used for corrective water, electrolyte, and acid base balance (12.9%) and medicines acting on the gastrointestinal tract (10.6%) (32). Similar findings were also reported from the Awi zone Ahmara regional state, in which anti-infective medicines were the most wasted medicines (36.4%), followed by ant pain medications (21.4%) and cardiovascular medications (11%)(20). The high level of anti-infective medicine wastage in developing countries might be due to communicable diseases being the most prevalent diseases and anti-infective being the primary medicine to treat this disease. As a result, their prevalence in wastage may also show that they are the most commonly utilized and abused medicines at health facilities. In addition, high wastage ant infections in the current study area might be due to abrupt treatment changes in communicable diseases, such as HIV/AIDS, malaria, and TB, in which large amounts of medicines were left unused and expired. The perceived contributing factors for medicine wastage The major contributing factors were near-expiration medicines being delivered to health facilities, no participation of clinicians in medicine selection and quantification, abrupt change treatment practices resulting in medicine wastage, the presence of overstocked medicines due to improper forecasting and lack of accountability for stock out and wastage medicine. Similar findings were also reported from Uganda, Tanzania and Ethiopia, in which short shelf life, improper forecasting of need that leads to overstock, poor storage practices, poor inventory control, stop/change of medicines and lack of accountability for stock out and wastage medicines were the major factors for high wastage rates of medicines (16,32,36). This might be mainly due to weak communication between medicine managing stakeholders and low participation of clinicians in medicine selection and quantification. This study identified abrupt change treatment practices resulting in medicine wastage in health facilities as one of the contributing factors for medicine wastage. This finding was witnessed in Uganda, in which huge stocks of chloroquine, sulfadoxine/pyrimethamine and isoniazid were expired due to changes in treatment practice(36). This might be due to poor management of a change in treatment policy. However, this can be minimized by decreasing the entry of phased-out medicines into the market before implementation of the change. The other identified factor for medicine was the delivery of nearly expired medicines (< 6 months) to the health facilities by the suppliers. The provision of near-to-expiration medicines by EPSA was another contributing factor identified in the present study. This finding is in line with studies conducted in South Africa (41) and in the southwest Shoa Zone, Oromia Regional State, Ethiopia (32). This might be due to weak information exchange about the stock status of medicine between EPSA and health facilities as well as the provision of EPSA to reduce its medicine wastage rate below 2%. This study also identified the presence of overstocked medicines due to improper forecasting of need in the health facilities as the major cause of medicine wastage. Both in the survey and in-depth interview mentioned that the provision of medicines without needs by suppliers resulted in the stocking of medicines. Similarly, a study performed in Uganda and Tanzania showed that over stocking of medicines was one of the major contributing factors for expiry of medicines (16, 36) Poor quantification and forecasting of medicines will lead to overstocking of the medicines. Overstocking of medicines normally leads to a high number of expired medicines, high cost of storing excess stock and high incidences of pilferage of highly potent medicines (8). This might bed to poor utilization of consumption data and nonparticipation of clinicians during forecasting and selection medicines. Thus, public health facilities need a great effort to reduce the rate of expiration by improving medicine quantification and selection. Lack of accountability for stock out and wastage medicine in the health facilities was also among the major causes of medicine wastage cited by key informants. Ineffective monitoring and accounting mechanisms, corruption and poor record-keeping are among various factors that cause the wastage of limited resources due to theft, bribery and fraud (8). A study conducted in Ethiopia stated that poor documentation of wastage and pilferage and the absence of accountability on the part of health facilities to properly document and report wastage in the pharmaceutical sector are believed to significantly contribute to most of the challenges in medicine management, which have resulted in multiple forms of irrational practices and waste (10). The present study also identified nonparticipation of clinicians in medicine selection and quantification as one of the contributing factors for medicine wastage. A similar study conducted in Uganda revealed that nonparticipation of clinicians in medicine quantification in hospitals, profit- and incentive-based quantification, and third-party procurement by vertical programmes and overstocking were the main causes of medicine wastage (36). The selection of medicines without proven evidence and techniques results in wastage due to expiry (8). Thus, the final medicine selection criteria should be based on discussion and acceptance by a multidisciplinary committee of experts. Limitations of the study The wasted medicines without price list were not included in the study. Difficult to inference on medicine wastage perceived factors due to lack of inferential statistical test. Conclusion The study revealed that Dire-Dawa public health facilities medicines wastage rate was above the acceptable limit 2%. The medicines wastage rate was 3.07%. The most common therapeutic classes of wasted medicines in terms of value were anti-infective, medicines used in endocrine disorders and contraceptives and gastrointestinal medicines. Near expiry medicines are being delivered to health facilities, no participatory of clinicians in medicine selection and quantification, abrupt change treatment practices results medicines wastage, presence of over stocked medicines due to improper forecasting and lack of accountability for stock out and wastage medicine were major perceived contributing factors. Abbreviations LMIC; Low and middle income countries, EFY; Ethiopian fiscal year, ETB; Ethiopian Birr, EPSA; Ethiopian Pharmaceutical Supply Agency, DTC; Drug and Therapeutic Committee, ADR; ART; Anti Retroviral Therapy and TB; Tuberculosis, STG; Standard treatment guideline Declarations Acknowledgments We would like to thank Dire-Dawa University, College of Medicine and Health Sciences, and IRB for their technical support and for giving us clearance to conduct this study. A great deal of gratitude goes to data collators and study participants, especially Competing interests No conflicts of interest to disclose. Availability of data and materials All relevant data are within the paper. Authors’ contributions All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; agreed on the journal to which the article has been submitted; and agreed to be accountable for all aspects of the work. Ethics approval and consent to participate This study was ethically approved by the Institutional Ethics Review Committee of Dire Dawa University. The ethical letter was written to the Dire-Dawa city administration health bureau, and an official letter of permission was written to each respective health facility official before data collection. Voluntary written consent was obtained from each study participant. Consent for publication. Not applicable References Summers, R. S. and Mackie CA. 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Integrated Pharmaceuticals Logistics System (IPLS) in Health Facilities of Ethiopia. 2017;1–118. Law A V., Sakharkar P, Zargarzadeh A, Tai BWB, Hess K, Hata M, et al. Taking stock of medication wastage: Unused medications in US households. Res Soc Adm Pharm [Internet]. 2015;11(4):571–8. Available from: http://dx.doi.org/10.1016/j.sapharm.2014.10.003 Braund R, Peake BM, Shieffelbien L. Disposal practices for unused medications in New Zealand. Environ Int [Internet]. 2009;35(6):952–5. Available from: http://dx.doi.org/10.1016/j.envint.2009.04.003 Peltoniemi T, Suomi R. y. J Pharm Policy Pract. 2019;12(1):1–7. Kusturica MP, Tomas A, Tomic Z, Bukumiric D, Corac A, Horvat O, et al. Analysis of Expired Medications in Serbian Households Analiza Kopičenja Zdravil S Pretečenim Rokom Trajanja V Srbskih Gospodinjstvih. Slov J Public Heal 55. 2016;55(3):195–201. Trueman P, Lowson K, Blighe A, Meszaros A. Evaluation of the Scale, Causes and Costs of Waste Medicines Evaluation of the Scale, Causes and Costs of Waste Medicines. York Heal Econ Consort [Internet]. 2011;17:327–49. Available from: http://evi.sagepub.com/cgi/doi/10.1177/1356389011421697 Vogler S, Leopold C, Zuidberg C, Habl C. Medicines discarded in household garbage: Analysis of a pharmaceutical waste sample in Vienna. J Pharm Policy Pract. 2014;7(1):1–8. Jassim AM. In-home drug storage and self-medication with antimicrobial drugs in Basrah, Iraq. Oman Med J. 2010;25(2):79–87. Levenger M, Ongeri B, Wolde A, Kagoya HR. Namibia National Supply Chain Assessment. Submitt to US Agency Int Dev by Supply Chain Manag Syst. 2013;(September). 31..El-Hamamsy M. ME-HA. UNUSED MEDICATIONS: HOW COST AND HOW DISPOSAL OF IN CAIRO, EGYPT.. Int J Pharm Stud Res. 2011;16:21–27. Gebremariam ET, Gebregeorgise DT, Fenta TG. Extent of medicines wastage and its contributing factors in public health facilities of south west Shoa Zone, Oromia Regional State, Ethiopia: a cross-sectional survey. Ethiop Pharm J. 2019;34(2):143. West LM, Diack L, Cordina M, Stewart D. A systematic review of the literature on ‘medication wastage’: an exploration of causative factors and effect of interventions. Int J Clin Pharm. 2014;36(5):873–81. Ababa A. (SOPs) manual for drug and therapeutics committee in health. 2016; Adzimah ED, Gyawu MA-, Agyemang P. AN assessment of healthcommodities management practices in health care delivery; a supply chain perspective. the case of. 2014;(January 2019). Nakyanzi JK, Kitutu FE, Oria H, Kamba PF. Expiry of medicines in supply outlets in Uganda. Bull World Health Organ. 2010;88(2):154–8. Kokilam MB, Joshi HG, Kamath VG. Assessment of Pharmaceutical Store and Inventory Management in Rural Public Health Facilities – A study with reference to Udupi. 2015;6(2):53–9. Iqbal MJ, Geer MI, Dar PA. Original Article Indicator Based Assessment of Medicine Storage and Inventory Management Practices in various Public Sector Hospitals of District Srinagar. 2015;1(2):8–15. Tesfaye A. Assessment of Pharmaceutical Store Management in Public Hospitals, Addis Ababa, Ethiopia Ayalew Tesfaye. 2020;(September). Sauls C. Trend in revenue loss due to expired medication at a large urban hospital in Johannesburg, South Africa. 2016;(June). Fentie M, Fenta A, Moges F, Oumer H, Belay S, Sebhat Y. Availability of Essential Medicines and Inventory Management Practice in Primary Public Health Facilities of Gondar Town, North West Ethiopia. 2015;4(2):2–4. Ababa A. Pharmacy Services, Pharmaceuticals Supply Chain & Medical Device Management Monitoring and Evaluation Framework Participan T ‟ S Training Manual. 2019; Ababa A. National Essential Medicine List Fifth Edition Addis Food, Medicine and Healthcare Administration and Control authority of Ethiopia. 2014; Available from: http://apps.who.int/medicinedocs/documents/s22351en/s22351en.pdf Tumwine Y, Kutyabami P, Odoi RA, Kalyango JN. Availability and expiry of essential medicines and supplies during the “Pull” and “Push” drug acquisition systems in a Rural Ugandan Hospital. Trop J Pharm Res. 2010;9(6):557–64. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1842136","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":120683294,"identity":"8a566a2f-564f-4510-a907-ed414ff3d28a","order_by":0,"name":"Abera Bedasa","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Abera","middleName":"","lastName":"Bedasa","suffix":""},{"id":120683295,"identity":"4d7e05de-c6a4-430f-bc56-3306bc28b808","order_by":1,"name":"Neil Abdurashid","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFUlEQVRIiWNgGAWjYBAC9mYGBgkkvgQ/P4hKKMCthecwmhbJmQ0gLQZ4tBxA1cIgueEAiMKnhZ334Y2PbXXyBjfSH36u+GMhYXx+deKHBwYM8vxiB7BrYWY3tpzZdthww42EZMmzbRISZjfebpYAOsxw5uwErFrsmdnYpHm3HWAEajkg2dggUWd24+wGkJYEg9vYtfBAtNTZb7iR2Pyz4Y+EhPGMs5t/EKGFOXHDjWQ2yQY2CQkD/t5thGxhtpz573DyzDPP2CwbgX6RuMG7zSLBQAKnX3j4jzHe+HCmzrbvePrjmw1/6iT4+89uvvmjwkaeXxq7FjhQOABjSYBVSuBSiADyDTAW/wHcqkbBKBgFo2BEAgBJV11q5Avl0wAAAABJRU5ErkJggg==","orcid":"","institution":"Dire-Dawa University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Neil","middleName":"","lastName":"Abdurashid","suffix":""},{"id":120683296,"identity":"de6bf079-17a1-4730-92cf-84732b634217","order_by":2,"name":"Kiber Argaw","email":"","orcid":"","institution":"Dire-Dawa University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kiber","middleName":"","lastName":"Argaw","suffix":""}],"badges":[],"createdAt":"2022-07-09 16:14:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1842136/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1842136/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":23879028,"identity":"0a7e9465-3ab3-4f7e-a3e7-a4adaf33604d","added_by":"auto","created_at":"2022-07-14 19:07:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28328,"visible":true,"origin":"","legend":"\u003cp\u003eTrend of the medicine wastage rate of Dire-Dawa administration public health facilities, Ethiopia (EFY2010-2012), June 2021\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-1842136/v1/2a471eb25a0a27739c596721.png"},{"id":23879027,"identity":"fc479ccd-a3ed-4fe7-893e-8b090df6fd58","added_by":"auto","created_at":"2022-07-14 19:07:47","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":4022,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage of wastage of medicines by reasons in the study facilities (EFY2010-2012), Dire-Dawa city administration, June 2021\u003c/p\u003e","description":"","filename":"Onlinedrawingimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-1842136/v1/9bce8f3fb367786a029bbf9d.png"},{"id":23879029,"identity":"a6336bf8-e7f8-4ae0-82cb-2fae820a8cd4","added_by":"auto","created_at":"2022-07-14 19:07:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":546789,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1842136/v1/b936420b-5c2a-4b34-8fd2-a4a780320830.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eMagnitude of Medicine Wastage and Perceived Contributing Factors Among Public Health Facilities in Dire Dawa City Administration, Eastern Ethiopia in COVID-19 Pandemic in Ethiopia\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eInternational agreements and national governments around the world all recognize the right to health as a fundamental human right. Medication has long been a necessity in healthcare programs, and it has significantly improved population health over time (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).The World Health Organization defines pharmaceutical or medication waste as products that are no longer in use, have been spilled, or are contaminated. This includes drugs, vaccines, and sera (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The volume of pharmaceutical waste has increased as a result of an increase in patients and prescriptions, increased usage, and overproduction of pharmaceuticals (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhen medication is available and properly administered, it plays a critical role in the provision of healthcare and has been shown to increase patient attendance and client satisfaction (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Pharmaceuticals that are out-of-date or past their expiration date endanger both the environment and the healthcare system (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Due to the healthcare system's financial limitations, as well as the enormous amounts of medication that are wasted and the associated disposal costs in low- and middle-income countries, both the healthcare system and the overall economy will be seriously threatened (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). As worrying as the disposal of expired medications are the financial losses imposed on national healthcare systems and on particular patients. Pharmaceutical waste also poses a significant risk to the environment and has negative impact on public health if improperly disposed of.\u003c/p\u003e \u003cp\u003eIn areas where unused medications were disposed of, numerous types of bacteria resistant to antibiotics were discovered (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). It has been shown that antibiotics that accumulate in aquatic environments worsen antibiotic resistance and affect the pathogenicity of microorganisms (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Additionally, the amount of necessary medications that patients have access to and the level of care they receive are both decreased as a result of prescription waste, putting human life in danger (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe degradation of medicines can be brought on by unsanitary storage conditions, such as placing medicines directly on the floor, not organizing the stock in a systematic way, having dust and pests, not providing adequate protection from direct sunlight, and not having temperature control charts or facilities to monitor room temperature. Additionally, inadequate inventory control, which is blamed for the loss of 4 to 9 percent of pharmaceuticals in overall supply systems, is cited as a contributing factor (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). More than half of all medicines are inappropriately prescribed, dispensed or sold. Such techniques are thought to be more common in healthcare settings in underdeveloped countries, where there are still weak routine monitoring procedures for medication use (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to Variant Market Research, an Indian data mining and information analysis company, the global over-the-counter drug (OTC) market is expected to grow from USD 125\u0026nbsp;billion in 2016 to USD 273\u0026nbsp;billion by 2024. Only a small portion of this is currently being used, and the majority will eventually be wasted or expire, generating a sizable amount of pharmaceutical waste (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).The annual costs associated with unused prescription medications are estimated by the National Health Service of the United Kingdom (UK) to be \u0026pound;300\u0026nbsp;million (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite a significant sum of money spent on drug procurement, one-third of the world's population lacks access to medicines, which rises to one-half in Asia and Africa. This explanation is that due to a poor medicine management system, up to 70% of resources have been wasted.(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). A Tanzanian study found that up to 51.1% of the total amount of prescribed medications were wasted (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDrug waste in low-income countries is a result of inadequate supply chain management systems. In addition to patient-related considerations, this includes tactics that might lead to medication over- or under-stocking as well as the selection and quantification of medications without the use of reliable data or supporting evidence. (Patient death, switching medications, discontinuing therapy, side effects, and low patient compliance) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOne of the difficulties in managing Ethiopia's medical supply chain is drug waste (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).The Health Sector Development Program (HSTP II) has as its national objective to reduce the wastage rate of medicines to below 2%, but the reality is very different (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Ethiopia, like other developing countries, must pay close attention to a problem with the health supply chain caused by drug waste. The three-year (2012, 2013, and 2014) average medicine wastage rate in 8 hospitals was 4.8 percent, amounting to 11,078,910.52 ETB, according to an evaluation carried out in 2013/2014 during the collection of Auditable Pharmaceutical Transaction and Services (APTS) baseline data in Federal and Addis Abeba city government hospitals (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The primary causes of medical waste in Ethiopia are poor governance, a lack of auditing procedures, transparency, and accountability in the pharmaceutical system, which increase healthcare costs and deplete the nation's meager health system resources (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Additionally, there aren't enough regulations requiring medical facilities to monitor and report drug waste across the country or tools to automatically collect waste. Due to all of these factors, Ethiopia wastes a significant amount of medicine, necessitating immediate attention and action (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Poor documentation, a lack of accountability, a lack of tools or software that automatically collect data, and a lack of a system requiring health facilities to record and report wastage to the body in the supply chain that is directly affected are all causes of medicine waste in Ethiopia (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to a study conducted in the Awi zone, the Pharmaceuticals Fund and Supply Agency (PFSA) frequently pushed program products and occasionally Revolving Drug Fund items at the medical facilities that were unnecessary and occasionally on the verge of expiration. A lack of data during service expansion, problems with reporting consumption data from wards, failure to take quantity into account when ordering, a store employee's lack of inventory management skills, the ineffectiveness of medications or lack of response and the ensuing change are additional factors. They include different prescription practices used by prescribers, quantification issues (particularly with seasonal products), poor data quality, and an ineffective Drug and Therapeutics Committee (DTC). The main factors behind the ward's insufficient use of medications were health professionals' knowledge gaps (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Dire-Dawa city administration, medications are regularly discarded by the Dire-Dawa regional health bureau from public health facilities; however, the type and extent of medicine waste as well as its contributing factors were not investigated. Therefore, this study provides information about the extent, identifies the types of wasted medicines and their underlying causes and fills the gaps in how to properly utilize medicines and minimize the wasted cost of money by developing different strategies in the public health facilities of Dire-Dawa city administration.\u003c/p\u003e"},{"header":"Methods And Materials","content":"\u003cp\u003e\u003cstrong\u003eStudy area and period\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in the Dire Dawa Administrative city, which is located 515 km away from Addis Ababa. The current projected the Metro area of Dire Dawa in 2020 was 408,000 a 4.35% increase from 2019.\u0026nbsp;According to the report by the Dire-Dawa health\u0026nbsp;bureau, during the surveying time the city administration had 2 public hospitals (Dill Chora Hospital and Sabian Hospital), 15 health centers and 35 health posts. Apart from these, there were 1 Hospital, 3 primary Hospital, 32 medium clinics, 7 primary clinics, 17 pharmacy, 53 drug stores, 3 diagnostic laboratories possessed by private owners.\u0026nbsp;A facility-based cross-sectional study was conducted by supplemented \u0026nbsp;qualitative study design that was employed from May 10 to June 19, 2021.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling size determination and sampling technique\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll health facilities that fulfilled the inclusion criteria were included in the study. All public health facilities which had more than 3 years in operation\u0026nbsp;and health professionals involved in pharmaceutical management in Dire-Dawa city administration were included in the study. No sampling method was used because all 17 health facilities (2 Hospitals and 15 health centers) were included in the study. Out of these one health center was selected for pretest which was excluded from study during data collection, finally a total of 16 health facilities were included in the study. \u0026nbsp;For quantitative study the number of study \u0026nbsp;population ( all health professional engaging in Drug and therapeutic committee (DTC) and all pharmacy professionals working in 16 public health facilities of Dire-Dawa city administration \u0026nbsp;were\u0026nbsp;163 and for qualitative study the number of study population, (the chief executive officers (CEOs)/Health center head, pharmacy store manager and pharmacy departments head working in 16 public health facilities of Dire-Dawa city administration) was 48.They were purposively selected as a key informant because they were supposed to be information rich than other health professionals. \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Quality control\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study questionnaire was developed after reviewing different literature and made available in English to be read and a pretest study was performed in one of public health facilities.\u003c/p\u003e\n\u003cp\u003eTwo pharmacists for data collectors were involved by using data abstraction formats and self-administered questionnaires and principal investigator through in-depth interview with the CEOs/health facility head, pharmacy store manager and pharmacy department head. Data collectors received training for one day. To collect the qualitative data, the principal investigator conducted in-depth interviews using the IDI guide to understand the perceptions of participants about the medication wastage. The principal investigator used a tape recorder to record the interview and filed notes on important points. Appropriate personal protective equipment (PPE), such as sanitizer and a facemask, was used by the data collectors and the study participants before undergoing data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData instrument and Processing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe quantitative data was collected through record review by recording each pharmaceutical on the data abstraction form. Records that were reviewed include: physical inventory report, records of medicines wastage, disposal reports, model 19 and HCMIS (DAgu2). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMedicines wastage recording format and wasted value recording format were prepared based on pharmaceutical monitoring and evaluation framework (42) and EFMHACA medicines waste management and disposal directive(43).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Self-administered questionnaire which has perceived contributing factors of medicines wastage was amended from literature. Every point is score on a 5 point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) (36)\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA semi-structured interviewer-administered \u0026nbsp;questionnaire\u0026nbsp;about condition of medicines wastage, contributing factors, concerns and efforts in preventing or minimizing the problem for store personnel, pharmacy heads, and medical directors were developed after literature search (16,44).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData entry analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFor quantitative study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSelf-administered questionnaires were entered in to Epi Data version 3.1 then exported to SPSS version 20 for analysis Descriptive statistics (Frequency, Mean, Standard Deviation (SD), percentage and graph) were used to summarize the results. Self-administer questionnaire with a 5- point likert scale ranging from 1(strong disagree) to 5 (strong agree) was used to identify perceived contributing factors for medicine wastage. The perceived factors which had highest mean score (mean\u0026plusmn; SD)\u0026gt;=4 were the most commonly perceived factors contributing to medicine wastage. Excel sheet was used for calculating medicine wastage for each public health facilities \u0026nbsp;through dividing total cost of medicines wasted \u0026nbsp;from medicines wastage registration and disposed medicines lists \u0026nbsp;by total cost of medicine available for sale during review period. The value of wasted medicine was grouped by dosage form and pharmaco-therapeutic classes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFor the qualitative study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe principal investigator had had undergone in-depth interview to understand the perceptions of participants about the medication wastage. The investigator transcribed the audio recorded in-depth interviews and discussions verbatim. Audio-recordings and notes were translated into English. Then codes were given and issues were discussed and themes were developed. Later, the text relating to each code/theme was discussed and summarized in sub themes and presented the findings using quotes. The codes were developed from the texts and it was categorized as the following terms: current situation of medicines wastage, medicine wastage and its contributing factors. The themes that developed from the codes would be supplemental for reasons for medicine wastage and factors leading to medication wastage. Each transcript was carefully screened and triangulated with the quantitative result.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance was obtained from the Ethics Review Committee of Dire Dawa University, and a formal letter of cooperation was written to the Dire-Dawa city administration health bureau and to each respective public health facilities. Data collectors were trained how to handle sensitive issues and on the importance of keeping confidentiality. Informed voluntary written and signed consent was obtained from all study participants prior to undertaking interview. During the consent process, the respondents were informed about the purpose, procedures, potential risk and benefit of the study and what was expected from them, their rights to participate or not in the study. Information provided by respondents was not transferred to a third party or was used for any other purpose other than academic. Thus, they were assured of utmost confidentiality and anonymity of their responses. In this regard, the names of the respondents were not disclosed. The room and the environment were made conducive to maintain their privacy and to prevent COVID-19 transmission.\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003eThe data were gathered from primary sources using data abstraction formats, self-administered questionnaires and semi structured interview questionnaires. A total of 16 public health facilities (14 health centers and 2 general hospitals) were included in the studies. Of these facilities, 13 (2 general hospitals and 11 health centers) executed HCMIS initiatives, while APTS initiatives were implemented only in town health facilities. The results presented include the magnitude of the medicine wastage rate in each public health facility and Dire-Dawa city administration, therapeutic class of wasted medicine, dosage form of wasted medicines, reason for medicine wastage, perceived factors contributing to medicine wastage and the qualitative data presented thematically by narration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuantitative findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMagnitude of medicine wastage\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe average wastage rate of medicines from the budget and program between 2010EFY and 2012EFY in two public hospitals and fourteen health centers in Dire-Dawa were found to be within a range of 0.36% to 5.8%. The highest average wastage rate was identified in Sabian General Hospital, which was 5.8%. Within the above specified time, the overall city administration wastage was 4048594.00ETB, accounting for an average wastage rate of 3.07% of the total value of medicines available for sale at sixteen public health facilities. Similarly, the medical supply and laboratory reagent amount to 275335.00 ETB and 559618.80ETB, respectively, were wasted. In EFY 2010, there was an overall wastage of 1404987.7 ETB, accounting for an average of 3.3% of the total value of medicines available for sale by sixteen health facilities. In 2011 EFY, the value of wastage was estimated to be 1204188.00 ETB, indicating an annual wastage rate of 2.7% for sixteen of the study health facilities, while in 2012EFY, there was an overall wastage of 1439418.284 ETB, in which the annual wastage rate was estimated to be 3.2%. \u003cstrong\u003e(Table-1)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:115%;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTable 1. The value of medicines (available for sale and wasted) and estimation of total medicine wastage rate in the facilities (EFY2010-2012), Dire-Dawa city administration, Ethiopia, June 2021 (n=16)\u003c/p\u003e\n\u003ctable style=\"width: 4.8e+2pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48.1pt;border: 1pt solid windowtext;padding: 0in 5.4pt;height: 26.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eHealth facility code\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 140.65pt;border-color: windowtext windowtext windowtext currentcolor;border-style: solid solid solid none;border-width: 1pt 1pt 1pt medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 26.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2010EFY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 153pt;border-color: windowtext windowtext windowtext currentcolor;border-style: solid solid solid none;border-width: 1pt 1pt 1pt medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 26.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2011EFY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 139.5pt;border-color: windowtext windowtext windowtext currentcolor;border-style: solid solid solid none;border-width: 1pt 1pt 1pt medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 26.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2012EFY\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55.15pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 96.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003emedicine available for sale in birr\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 96.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003ewasted in birr\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 96.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eWastage rate (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 96.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003emedicine available for sale in Birr\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 96.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003ewasted in Birr\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 96.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eWastage rate (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 96.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003emedicine available for sale in Birr\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 96.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003ewasted in Birr\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 96.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eWastage rate (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 48.1pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp 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style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e6058.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 48.1pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eJBHC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.15pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e410900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e14649\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e420630\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e17098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e551500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e18763\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 48.1pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003ewastage rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55.15pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e42183564\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1404987\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e44670031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1204188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e45257064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1439418\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:115%;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTypes of wasted medicines\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClasses of wasted medicines\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 237 types of medications were wasted at the 2 hospitals and 14 health centers in the period of EFY 2010-2012. Anti-infective medications were found to be the most wasted medications at 2360330.33ETB (58.3%), followed by endocrine medications at 647775.05ETB (16%) and gastrointestinal medications at 368422.06 ETB (9.10%). \u003cstrong\u003e(Table 2).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:115%;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTable 2. Estimated value of wastage of medicines by classes in the study facilities (EFY2010-2012), Dire-Dawa city administration, June 2021\u003c/p\u003e\n\u003ctable style=\"width:476.75pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 287.75pt;border: 1pt solid windowtext;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eclass of medicines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 189pt;border-color: windowtext windowtext windowtext currentcolor;border-style: solid solid solid none;border-width: 1pt 1pt 1pt medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003evalue of wasted medicines\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eCost(Birr)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 287.75pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eAnt-infective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2360330.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e58.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 287.75pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 3.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eMedicine used in endocrine disorder and contraceptives\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 3.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e647775.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 3.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 287.75pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGastrointestinal medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e368422.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 287.75pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 4.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eCardiovascular medicines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 4.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e214575.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 4.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 287.75pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eCentral nervous system medicines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e149798.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 287.75pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 12.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eVitamin and minerals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 12.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e117409.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 12.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 287.75pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 8.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eAnalgesics/antipyretics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e85020.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 287.75pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 11.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eMedicine for corrective water electrolyte and acid -base disturbance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e52631.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 287.75pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 10.3pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eAntihistamine and ant allergic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 10.3pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e35627.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 10.3pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 287.75pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eRespiratory medicines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e17004.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 287.75pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4048594\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMedicine wastage by dosage form\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWasted medicine was categorized into different dosage forms. Out of the wasted medicines, oral medicines were the most wasted in terms of the monitory value 3348187.278 (82.7%), followed by parenteral 495952.7709 (12.25%) and Trans dermal 126720.9937 (3.13%). \u003cstrong\u003e(Table 3)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:115%;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTable 3. Estimated values of wastage of medicines by dosage forms in the study facilities (EFY2010-2012), Dire-Dawa city administration, Ethiopia, June 2021.\u003c/p\u003e\n\u003ctable style=\"width:458.75pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 206.75pt;border: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eType of dosage form\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166.5pt;border-color: windowtext windowtext windowtext currentcolor;border-style: solid solid solid none;border-width: 1pt 1pt 1pt medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eValue in ETB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;border-color: windowtext windowtext windowtext currentcolor;border-style: solid solid solid none;border-width: 1pt 1pt 1pt medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 206.75pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTablet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2615391.755\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e64.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 206.75pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eCapsule\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp 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style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e89069.06907\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 206.75pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eSuppository\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e64777.50478\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 206.75pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eSolution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e34413.04941\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 206.75pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eOintment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e24696.4237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 206.75pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eDrop\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e12550.64155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 206.75pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eJell\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2024.297024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 206.75pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eAerosols\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e404.8594049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 206.75pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4048594.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReasons for medication wastage \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eReasons for medicine wastage were assessed during the study period. Expiration of medicine was found to be the major reason for medicine wastage, accounting for 3951427.791 ETB (97.6%) of the total value of medicine wasted, followed by damage 97166.25717ETB (2.4%). None of the health facilities under study recorded theft pilferage and Obsolete as the reason for medicine wastage. \u003cstrong\u003e(Figure 2)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMedicine wastage perceived contributing factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDemographic Characteristics of Respondents\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaires were distributed to 163 health professionals, for a response rate of 161 (98.77%). The study included 92 (57.1%) males. The majority of the respondents 102 (63%) were between 31 to 40 years old. Regarding educational status, 42 (26.1%) were diploma pharmacy graduates, and 41 (25.5%) were pharmacists. The majority of respondents (104, 64%) had 5-10 years of work experience. \u003cstrong\u003e(Table\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:115%;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTable 4. Demographic features of self-administered questionnaire respondents in public health facilities, Dire-Dawa, June 2021 (n=161)\u003cspan style=\"color:#44546A;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"border-collapse: collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130.25pt;border: 1pt solid windowtext;padding: 0in 5.4pt;height: 8.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eDemography\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103.45pt;border-color: windowtext windowtext windowtext currentcolor;border-style: solid solid solid none;border-width: 1pt 1pt 1pt medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 8.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: windowtext windowtext windowtext currentcolor;border-style: solid solid solid none;border-width: 1pt 1pt 1pt medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 8.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eFrequency n =161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: windowtext windowtext windowtext currentcolor;border-style: solid solid solid none;border-width: 1pt 1pt 1pt medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 8.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003ePercent (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 130.25pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 4.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 4.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 4.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 4.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e57.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 3.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 3.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 3.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e42.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 130.25pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 8.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e20-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e30-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" style=\"width: 130.25pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 10.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eProfession\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 10.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003ePharmacist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 10.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 10.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e25.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eDiploma pharmacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e26.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eBSC nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e17.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGeneral practitioner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eDiploma nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eBSC laboratory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eHealth officer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 130.25pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 6.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eWork experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 6.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026lt;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 6.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 6.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 6.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e5-10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 6.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 6.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026gt;10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:115%;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived contributing factors to medicine wastage\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study revealed that the major medicine wastage contributing factors were near expiration medicines being delivered to health facilities, no participation of clinicians in medicine selection and quantification, abrupt change treatment practices resulting in medicine wastage, the presence of overstocked medicines due to improper forecasting and lack of accountability for stock out and wastage medicine. \u003cstrong\u003e(Table\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:115%;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTable 5. The perceived factors contributing to medicine wastage by health professionals in public health facilities of Dire-Dawa administration, Ethiopia, June 2021 (n=161).\u003c/p\u003e\n\u003ctable style=\"width: 4.7e+2pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 121.5pt;border: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eContributing Factors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" style=\"width: 254.5pt;border-color: windowtext windowtext windowtext currentcolor;border-style: solid solid solid none;border-width: 1pt 1pt 1pt medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 18.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 38pt;border-color: windowtext windowtext windowtext currentcolor;border-style: solid solid solid none;border-width: 1pt 1pt 1pt medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 18.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 58.5pt;border-color: windowtext windowtext windowtext currentcolor;border-style: solid solid solid none;border-width: 1pt 1pt 1pt medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 18.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eStandard deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0.5in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 70.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eStrongly\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eDisagree (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.55in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 70.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eDisagree \u0026nbsp;(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 70.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNeutral(3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 70.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eAgree(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 70.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eStrongly agree(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 70.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.5pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 35.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNear expiry medicines are being delivered to health facilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 35.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.55in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 35.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 35.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 35.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 35.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 35.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 35.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4.7\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 35.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.5pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNo participatory of clinicians in medicine selection and quantification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.55in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp 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style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eAbrupt change treatment practices results medicines wastage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 35.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.55in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 35.5pt;vertical-align: top;\"\u003e\n \u003cp 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style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 35.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 35.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 35.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 35.5pt;vertical-align: top;\"\u003e\n \u003cp 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51.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.55in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 51.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 51.7pt;vertical-align: top;\"\u003e\n \u003cp 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style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e3.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 51.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.5pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 43.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003elack of accountability for stock out and wastage medicine in the facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 43.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.55in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 43.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 43.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 43.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 43.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 43.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 43.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e3.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 43.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.5pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eAbsence of functional DTC in the health facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.55in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.5pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 36.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003epoor stock management like using neither FIFO nor FEFO in stock management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 36.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e37\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.55in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 36.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 36.5pt;vertical-align: top;\"\u003e\n \u003cp 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style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 36.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 36.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 36.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.5pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNo accurate data available in health facility to facilitate quantification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.55in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.5pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 37.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003elack of knowledge and skill of pharmacy professionals in medicine supply management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 37.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.55in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 37.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 37.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 37.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 37.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 37.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 37.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 37.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.5pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eMedicine purchased without procurement plan\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.55in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.5pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eSelection of medicines are not based on medicine lists of facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n 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style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.5pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eweak or no mechanism for medicine wastage monitoring and evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.55in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.5pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eLack of system to move nearly expired medicines facility to facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n 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style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.5pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eLack of electronic stock management tools that automatically capture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.55in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.5pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eMedicines are store on the floor not arranged systematical on shelf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n 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style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.5pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eMedicines that need cold temperature are not stored in a functionalrefrigerator in the health facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.55in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.5pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eShortage of pharmacy human resources in the facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.55in;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:115%;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe key informants (KIs) were interviewed to find information about the current situation of medicine wastage in their facilities, factors that contribute to medicine wastage, the effect of medicine wastage on service provision and ideas for improving medicine wastage. They included drug store personnel, pharmacy heads, and health facility\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocio-demographic characteristics of key informants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eForty-eight health professionals working in sixteen public health facilities participated in this study as key informant interviewees. Of these, forty-eight (67%) were males. The mean age of the respondents was 30.7 years (SD= \u0026plusmn;3.94), ranging from 26 to 42 years. In terms of profession, nineteen (39.9%) respondents were pharmacy technicians, thirteen (27%) were pharmacists, and nine (18.7%) were BSC nurses. The work experiences of the respondents ranged from 3 to 15 (6.8\u0026plusmn;3.25) years. \u003cstrong\u003e(Table\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;text-align:justify;line-height:115%;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTable 6. Demographic features of key informants in public health facilities, Dire-Dawa, 2021 (n=48).\u003c/p\u003e\n\u003ctable style=\"border-collapse: collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 274.45pt;border: 1pt solid windowtext;background: rgb(242, 242, 242) none repeat scroll 0% 0%;padding: 0in 5.4pt;height: 16.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"color:black;\"\u003eSocio-demographic profile\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.1pt;border-color: windowtext windowtext windowtext currentcolor;border-style: solid solid solid none;border-width: 1pt 1pt 1pt medium;border-image: none 100% / 1 / 0 stretch;background: rgb(242, 242, 242) none repeat scroll 0% 0%;padding: 0in 5.4pt;height: 16.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"color:black;\"\u003eNumber\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.6pt;border-color: windowtext windowtext windowtext currentcolor;border-style: solid solid solid none;border-width: 1pt 1pt 1pt medium;border-image: none 100% / 1 / 0 stretch;background: rgb(242, 242, 242) none repeat scroll 0% 0%;padding: 0in 5.4pt;height: 16.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"color:black;\"\u003ePercentage\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 105pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.1pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.6pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 169.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.1pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.6pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 105pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e20-30 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.1pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.6pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 169.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e31-40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.1pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.6pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 169.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 3.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026gt;40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.1pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 3.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.6pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 3.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" style=\"width: 105pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eProfession\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003ePharmacist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.1pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.6pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 169.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003ePharmacy technician\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.1pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.6pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 169.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eBSC nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.1pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.6pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 169.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eMSC nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.1pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.6pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 169.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eMSC health officer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.1pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.6pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 169.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eHealth officer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.1pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.6pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 169.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGeneral practitioner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.1pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.6pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 105pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 6.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003eWorking experience in years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 6.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026lt;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.1pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 6.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.6pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 6.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 169.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e5-10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.1pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.6pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 169.45pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026gt;10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85.1pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.6pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:13px;font-family:\"Times New Roman\",serif;'\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe situation of medicine wastage in public health facilities\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWith regard to wastage, most of the key informants stressed that it was a major problem in their health facilities due to acceptance of donation of near-to-expiration medicines and overestimation of medicine during disease outbreaks. Some informants felt that medicine wastage was decreasing from time to time due to proper utilization of the FEFO system.\u003c/p\u003e\n\u003cp\u003eAge range 35 to 40 year male pharmacy head mentioned the following:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Medicine wastage in our health facility is recently increasing due to donors pushing near expiry and excess products during the occurrence of different disease outbreaks in the region. For example, chikungunia, AWD and COVID-19, which are the main causes of the expiry of products, also push too many products, which results in an overstock of items. However, budget product wastage significantly decreases from time to time as a result of good forecasting practice. \u0026rdquo;\u003c/p\u003e\n\u003cp\u003eConversely, some respondents believe that their health facilities medicine wastage is decreasing mainly due to a strong inventor control system. A 41-year-old female hospital CEO explained that:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Our health facility medicine wastage is on decreasing as a result of strong medicine data recording by using both computerized and manual recording system which enhanced accessibility of information to pharmaceutical managers and administrative that helped us in taking appropriate action before it get wasted. \u0026ldquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived factors contributing to medicine wastage\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKIs were asked about the causes of the medicine wastage, and most of the respondents reported that no participation of clinicians in medicine selection and quantification, push near to expiry product from EPSA for program medicines, abrupt change treatment practices, presence of overstocked medicines due to improper forecasting during disease outbreak, lack of accountability for stock-outs and wastage of medicines in the facility were the main causes of the medicine wastage.\u003c/p\u003e\n\u003cp\u003eFemale store manager at her late 20s said that:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026ldquo;I think the main reason for medicine wastage in our health facility is the nonparticipation of prescribers in medicine selection during procurement. Sometimes clinicians prefer to prescribe certain medicines; hence, the other will expire due to a lack of consensus between the pharmacy department and prescribers. The other reason is pushing program products that are near-expiry and sometimes unnecessary at the health facilities; thus, it will expire before it is consumed.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eAnother key informant, a male health center director between the ages of 35 and 40, said:\u003c/p\u003e\n\u003cp\u003eThe main reason for medicine wastage is a sudden change in treatment practice. In our health facility program medicine, ART and TB medicine were especially wasted due to frequent changes in the treatment protocol. Another reason is pharmacy department is not accessed the lists of available medicine for prescribers as a result medicines are expired due to lack information.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eSome key informants mentioned that forecasting error during disease outbreak, Excess procurement of medicine due to fear of shortage medicine from market, poor DTC functionality, slow move medicine (psychotropic medicines, expensive drugs and medicine with potential ADR), Prescribers dependent medicine order, Prescribers not adhere to STG, lack of accountability for wasted medicines and shortage of reagent were responsible for medicines wastage.\u003c/p\u003e\n\u003cp\u003eA 33-year-old male pharmacy head mentioned:\u003c/p\u003e\n\u003cp\u003eSome reagent dependent products were frequently wasted when their reagents were not available. added that other main cause of medicine wastage was oversupply medicine by donor and regional health bureau during episode chikungunia virus, AWD and covid-19 outbreak.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eThe consequence of medicine wastage on health facilities service delivery\u003c/p\u003e\n\u003cp\u003eKey informants were asked for their view on the effect of medicine wastage on their service. The key informants disclosed that decreasing internal revenue and disposal costs, occupying space that could be used for usable medicines, environmental pollution and reducing client satisfaction were the main consequences mentioned by key informants.\u003c/p\u003e\n\u003cp\u003eAnother male health center head in his early 40s said that:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Health care need is increasing from time to time; however, annual medicine budget is constant or not significantly increases as result patients cannot get all medicine they need due to shortage of budget so this will be worsened when scarce resource is wasted. In addition, wasted medicine is occupies storage space that can be used for usable medicine.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIdeas for improving medicine wastage\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe respondents were asked to offer ideas on how to minimize medicine wastages in public health facilities. Participating clinicians in medicine selection and quantification, conducting regular discussion on medicine supply management with EPSA, using medicine transfer guidelines effectively, improving communication between prescribers and pharmacy departments, training for DTC and pharmacy professionals on medicine supply chain management were among the suggestions made to improve medicine wastage.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study mainly focused on assessing the medicine wastage rate, the class of medicines commonly wasted and its contributing factors in public health facilities in Dire-Dawa, Ethiopia.\u003c/p\u003e\n\u003cp\u003eIn this study, the average medicine wastage rate was found to be 3.07%, which is lower than the study done in southwest Shoa, zone (7.5%)(32)and Federal and Addis Ababa city government hospitals during the collection of the Auditable Pharmaceutical Transaction and Service (APTS) baseline data (4.8%) (12). This could be due to the implementation of different stock management initiatives, such as the integrated pharmaceutical logistic system (IPLS), auditable pharmaceutical transaction system (APTS), medicine transfer guideline, and electronic stock management tool. However, higher than the national target in the health Sector Transformation Program (HSTP, II) for medicines, the wastage rate is below 2% (9, 19). This might be due to receiving bulk and near expiration program medicines that will expire before being consumed by clients.\u003c/p\u003e\n\u003cp\u003eThe current study indicated a class of commonly wasted medicine. Anti-infective medications were found to be the most wasted medicines (58.3%), followed by medicines used in the endocrine system (16%) and gastrointestinal system (9.1%). Similar findings were reported by a study conducted at a tertiary hospital in Dar Es Salaam, Tanzania, in which anti-infective medicine wastage was 18.9%, cardiovascular medicine was 8.9%, and the other category was 23.7% of the total medicines dispensed (16). Another study conducted in Egypt, Cairo, also found that antibiotics were the most wasted medications (20.15%), followed by gastrointestinal system drugs (16.27) and cardiovascular system drugs (10.72%)(31). In addition, other studies conducted in Ethiopia also revealed that anti-infective medicines were the most wasted medicine. A study conducted in southwestern Shoa reported zone anti-infective (39.1%), followed by medicine used for corrective water, electrolyte, and acid base balance (12.9%) and medicines acting on the gastrointestinal tract (10.6%) (32). Similar findings were also reported from the Awi zone Ahmara regional state, in which anti-infective medicines were the most wasted medicines (36.4%), followed by ant pain medications (21.4%) and cardiovascular medications (11%)(20). The high level of anti-infective medicine wastage in developing countries might be due to communicable diseases being the most prevalent diseases and anti-infective being the primary medicine to treat this disease. As a result, their prevalence in wastage may also show that they are the most commonly utilized and abused medicines at health facilities. In addition, high wastage ant infections in the current study area might be due to abrupt treatment changes in communicable diseases, such as HIV/AIDS, malaria, and TB, in which large amounts of medicines were left unused and expired.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe perceived contributing factors for medicine wastage\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe major contributing factors were near-expiration medicines being delivered to health facilities, no participation of clinicians in medicine selection and quantification, abrupt change treatment practices resulting in medicine wastage, the presence of overstocked medicines due to improper forecasting and lack of accountability for stock out and wastage medicine. Similar findings were also reported from Uganda, Tanzania and Ethiopia, in which short shelf life, improper forecasting of need that leads to overstock, poor storage practices, poor inventory control, stop/change of medicines and lack of accountability for stock out and wastage medicines were the major factors for high wastage rates of medicines (16,32,36). This might be mainly due to weak communication between medicine managing stakeholders and low participation of clinicians in medicine selection and quantification.\u003c/p\u003e\n\u003cp\u003eThis study identified abrupt change treatment practices resulting in medicine wastage in health facilities as one of the contributing factors for medicine wastage. This finding was witnessed in Uganda, in which huge stocks of chloroquine, sulfadoxine/pyrimethamine and isoniazid were expired due to changes in treatment practice(36). This might be due to poor management of a change in treatment policy. However, this can be minimized by decreasing the entry of phased-out medicines into the market before implementation of the change.\u003c/p\u003e\n\u003cp\u003eThe other identified factor for medicine was the delivery of nearly expired medicines (\u0026lt; 6 months) to the health facilities by the suppliers. The provision of near-to-expiration medicines by EPSA was another contributing factor identified in the present study. This finding is in line with studies conducted in South Africa (41) and in the southwest Shoa Zone, Oromia Regional State, Ethiopia (32). This might be due to weak information exchange about the stock status of medicine between EPSA and health facilities as well as the provision of EPSA to reduce its medicine wastage rate below 2%.\u003c/p\u003e\n\u003cp\u003eThis study also identified the presence of overstocked medicines due to improper forecasting of need in the health facilities as the major cause of medicine wastage. Both in the survey and in-depth interview mentioned that the provision of medicines without needs by suppliers resulted in the stocking of medicines. Similarly, a study performed in Uganda and Tanzania showed that over stocking of medicines was one of the major contributing factors for expiry of medicines (16, 36) Poor quantification and forecasting of medicines will lead to overstocking of the medicines. Overstocking of medicines normally leads to a high number of expired medicines, high cost of storing excess stock and high incidences of pilferage of highly potent medicines (8). This might bed to poor utilization of consumption data and nonparticipation of clinicians during forecasting and selection medicines. Thus, public health facilities need a great effort to reduce the rate of expiration by improving medicine quantification and selection.\u003c/p\u003e\n\u003cp\u003eLack of accountability for stock out and wastage medicine in the health facilities was also among the major causes of medicine wastage cited by key informants. Ineffective monitoring and accounting mechanisms, corruption and poor record-keeping are among various factors that cause the wastage of limited resources due to theft, bribery and fraud (8). A study conducted in Ethiopia stated that poor documentation of wastage and pilferage and the absence of accountability on the part of health facilities to properly document and report wastage in the pharmaceutical sector are believed to significantly contribute to most of the challenges in medicine management, which have resulted in multiple forms of irrational practices and waste (10).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The present study also identified nonparticipation of clinicians in medicine selection and quantification as one of the contributing factors for medicine wastage. A similar study conducted in Uganda revealed that nonparticipation of clinicians in medicine quantification in hospitals, profit- and incentive-based quantification, and third-party procurement by vertical programmes and overstocking were the main causes of medicine wastage (36). The selection of medicines without proven evidence and techniques results in wastage due to expiry (8). Thus, the final medicine selection criteria should be based on discussion and acceptance by a multidisciplinary committee of experts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe wasted medicines without price list were not included in the study. Difficult to inference on medicine wastage perceived factors due to lack of inferential statistical test.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study revealed that Dire-Dawa public health facilities medicines wastage rate was above the acceptable limit 2%. The medicines wastage rate was 3.07%. The most common therapeutic classes of wasted medicines in terms of value were anti-infective, medicines used in endocrine disorders and contraceptives and gastrointestinal medicines. Near expiry medicines are being delivered to health facilities, no participatory of clinicians in medicine selection and quantification, abrupt change treatment practices results medicines wastage, presence of over stocked medicines due to improper forecasting and lack of accountability for stock out and wastage medicine were major perceived contributing factors.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eLMIC; Low and middle income countries, EFY; Ethiopian fiscal year, ETB; Ethiopian Birr, EPSA; Ethiopian Pharmaceutical Supply Agency, DTC; Drug and Therapeutic Committee, ADR; ART; Anti Retroviral Therapy and TB; Tuberculosis, STG; Standard treatment guideline\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank Dire-Dawa University, College of Medicine and Health Sciences, and IRB for their technical support and for giving us clearance to conduct this study. A great deal of gratitude goes to data collators and study participants, especially\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo conflicts of interest to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll relevant data are within the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; agreed on the journal to which the article has been submitted; and agreed to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was ethically approved by the Institutional Ethics Review Committee of Dire Dawa University. The ethical letter was written to the Dire-Dawa city administration health bureau, and an official letter of permission was written to each respective health facility official before data collection. Voluntary written consent was obtained from each study participant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSummers, R. S. and Mackie CA. Developing pharmacy practice A focus on patient care HANDBOOK \u0026ndash; 2006 EDITION. 2006;87. 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National Essential Medicine List Fifth Edition Addis Food, Medicine and Healthcare Administration and Control authority of Ethiopia. 2014; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://apps.who.int/medicinedocs/documents/s22351en/s22351en.pdf\u003c/span\u003e\u003cspan address=\"http://apps.who.int/medicinedocs/documents/s22351en/s22351en.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTumwine Y, Kutyabami P, Odoi RA, Kalyango JN. Availability and expiry of essential medicines and supplies during the \u0026ldquo;Pull\u0026rdquo; and \u0026ldquo;Push\u0026rdquo; drug acquisition systems in a Rural Ugandan Hospital. Trop J Pharm Res. 2010;9(6):557\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Medicine wastage, contributing factors","lastPublishedDoi":"10.21203/rs.3.rs-1842136/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1842136/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eWorld Health Organization refers medication waste as expired, unused, spilled, and contaminated pharmaceutical items, medications, vaccines, and sera. Budget constraints in financing the health care system together with huge amount of wastage and disposal costs of unused medications at LMIC create a serious risk to the economy, health care system and environment. Thus, the aim of this study was to assess the rate of medication waste and to identify contributing factors in public health facilities in Dire-Dawa city.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAn institution-based cross-sectional study was used with a qualitative study design from May 10 to June 10, 2021 at 2 public hospitals and 14 health centers. Self-administered questionnaires and data abstraction formats were used to obtain the quantitative data. In-depth interviews were used to obtain qualitative data. Excel sheets and SPSS version 20 were used to analyze quantitative data, and thematic analysis was used to analyze qualitative data.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e3.07% of medicines were wasted between 2010 and 2012 EFY, in Dire-Dawa public health facilities that worth 4,048,594.0 ETB. The most wasted class of medication was anti-infectives, accounting for 2,360,330 ETB (58.3%), while tablets 2,615,391. ETB (64.6%). Medical waste has been linked to several issues, including pushing nearly expired medications to healthcare institutions, lack of clinician involvement in medication selection and quantification, rapid changes in treatment regimens, and the existence of overstocked medication shelves.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe average rate of medication waste was higher than the allowed level of 2%. The only medications that should be accepted by medical facilities are those that can be used before they expire. All prescribers should receive lists of the drugs that are readily available from the pharmacy department, and clinicians should be involved in the quantification and drug selection processes to increase the effectiveness of the use of medications.\u003c/p\u003e","manuscriptTitle":"Magnitude of Medicine Wastage and Perceived Contributing Factors Among Public Health Facilities in Dire Dawa City Administration, Eastern Ethiopia in COVID-19 Pandemic in Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-07-14 19:07:45","doi":"10.21203/rs.3.rs-1842136/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"17257362-281f-42a8-afa7-1a207f84e07f","owner":[],"postedDate":"July 14th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-07-14T19:07:45+00:00","versionOfRecord":[],"versionCreatedAt":"2022-07-14 19:07:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1842136","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1842136","identity":"rs-1842136","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}